Blood pressure recording in the ambulatory patient and evaluation of cardiovascular risk

Many large epidemiological studies, such as the one going on in Framingham [1], have clearly established that hypertension is one of the major risk factors for cardiovascular diseases. Well controlled intervention trials have also clearly demonstrated that antihypertensive therapy can significantly reduce the incidence of complications such as stroke, congestive heart failure and possibly myocardial infarction [2-4]. There exists no doubt about the important causal relationship between elevated blood pressure and cardiovascular complications. The measurement of blood pressure has thus become one of the most frequent procedures carried out by any practising physician. Notwithstanding, some doubt has been expressed whether all patients with a slightly elevated blood pressure at the physician's office are indeed prone to suffer a heart attack or a stroke and need lifelong antihypertensive therapy [5, 6]. Does the casual blood pressure measurement at the physician's office accurately assess the risk of each individual patient of suffering a heart attack in the future?